Hip arthritis

The hip is a ball-and-socket joint. A smooth layer of cartilage covers the ball and the socket so that they glide against each other. In arthritis this cartilage wears thin, and the bone underneath becomes irritated, which causes pain and stiffness.

The most common type is osteoarthritis, which develops with age and is more likely with family history, earlier injury, or an abnormally shaped hip. Other causes include inflammatory arthritis such as rheumatoid arthritis, damage after an injury, hip dysplasia, and loss of blood supply to the ball of the hip (osteonecrosis, also called avascular necrosis).

Hip arthritis often does not feel like pain in the hip itself. Common signs are:

• Pain in the groin, or in the front of the thigh, buttock or knee
• Stiffness, especially in the morning or after sitting
• Difficulty putting on socks and shoes, or getting in and out of a car
• A limp, or pain that limits walking, stairs or exercise
• Pain at night or when lying on the affected side

Pain felt around the hip can also come from the spine, a tendon, or a bursa, so an examination matters before a treatment is chosen.

Your visit includes your history, a hip and spine examination, and a look at how you walk. X-rays of the pelvis and hip will usually show loss of joint space and other bone changes that confirm arthritis, if it is present. MRI or other imaging is used only when it is needed to clarify the diagnosis.

Although nothing can remove arthritis other than surgery, many people can be helped for a time without surgery, particularly when the arthritis is in earlier stages.

Nonsurgical options include targeted physical therapy for muscle strengthening, activity changes, a cane, anti-inflammatory medication when it is safe, weight management, and corticosteroid injections for temporary relief. These measures may help to ease symptoms but do not reverse the arthritis, and injections almost never work well for advanced disease. See nonoperative hip and knee care for details.

Surgery is worth discussing when hip pain limits daily activities, walking or sleep despite a fair trial of nonoperative care, or when imaging shows advanced joint damage and nonoperative care is unlikely to improve symptoms. There is no single X-ray finding that decides it. The decision is based on how much the hip limits your life.

Waiting does not usually make the operation impossible, but very advanced arthritis can cause weakness, stiffness and a limp that take longer to recover from. The timing is a conversation between you and your surgeon.

In a hip replacement the worn ball and socket are replaced with a metal and plastic or ceramic implant. Dr. Cooper performs hip replacements through the front of the hip, the direct anterior approach, working between muscles instead of cutting through them. Modern hip replacements are among the most reliable operations in medicine, with success rates exceeding 99% in many patients, and many last for decades. Most patients are up and walking with support on the day of surgery.